This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Background: Self-discharges from a hospital against medical advice (AMA) represent a fundamental disagreement between the patient and provider in terms of continuity of care. Information about the reasons for discharges AMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of discharges AMA. Little is known about the reasons for self-discharges AMA. The objective of this study was to identify the reasons for discharges AMA among patients admitted to the Medicine service at a large urban teaching hospital based on focus group interviews (FGIs). Methods: Healthcare providers and patients were recruited to participate in FGIs to discuss why patients self-discharged AMA. Five FGIs were held: three patient-only groups, one physician-only group, and one nurse/social worker group. Focus group interviews were transcribed and analyzed to identify themes within the patient and provider groups. Results: Eighteen patients, 5 physicians, 6 nurses and 4 social workers participated in the FGIs. Themes identified from the patient FGI included: drug abuse history, long waiting times, unattractive hospital environment, poor communication between the provider and the patient. Themes identified from the provider FGIs included: drug abuse history, poor communication between providers, poor communication between providers and patients, unhelpful nursing staff, and aloof/intimidating physicians. Poor communication was a common theme and the specific definition varied between patients and providers. Conclusions: In a large, academic medical center we find few differences and many similarities across patients and providers regarding the causes of discharges AMA, many of which relate to communication.